Books

Lessons Learned in changing healthcare... and how we learned them March 2011

Book Review: They will keep the torch high

James A. Dunbar

This ‘must read’ book is a Festschrift for Professor Paul Batalden, a great scholar and doyen of the movement for quality improvement in health care. For 30 years when the science of improvement was almost unknown in medicine, he has been its major intellectual stimulus. Inaugural Chair of the Board of the Institute for Healthcare Improvement, developing the Dartmouth Microsystem Improvement Curriculum, designing  the ‘collaboratives’, and embedding training in quality improvement into the US residency programs are just four of his huge contributions.

With its emphasis on experiential learning by clinical leaders, this book is classic Batalden. The book comes from a series of fourteen guest lectures given at Dartmouth Hitchcock Medical Center. The lecturers, all physicians were invited to reflect on the lessons they had learned while leading change in healthcare and how they learned them. The chapters are usually no more than five pages with a thumbnail sketch of the author and a few references.

Each chapter is a unique, individual gem of insight. Free of clichés, the authors describe their own experience faithfully. Each paragraph has a heading highlighting the personal learnings of the lecturer. Some themes come through strongly; measurement, honesty, and motivating people. Some ideas are new such as the importance of positive deviance. Organizational culture gets its due attention.

The last chapter is written by the maestro himself and displays the extraordinary breadth of his scholarship moving from French to Shakespeare, a quote from Pasteur and another from Tzu before settling on the importance of learning from experience. He talks about "learning buddies"- people with whom he has been able to test his thinking and reasoning over the years. Each paragraph heading is a lesson and there are thirteen of them. My favourites are: attraction and invitation are more powerful than command and control, framing and reframing  are essential leadership skills, the ladder of inference melts unnecessary conflict, there is an authoring (generative) dimension to authority, spend more time removing the toxicity of current incentives than trying to create new positive ones, and,  leaders usually get what they lead personally.

In Germany it is traditional for the retiring academic to invite his successor to prepare the Festschrift. Fittingly Batalden finishes his chapter on the importance of developing a number of successors. Lucky are those who have been fortunate enough to have been touched by his teaching. They will keep the torch high.

About the Author

Professor, Flinders University School of Medicine.

References

*Festschrift : A collection of essays or learned papers contributed by a number of people to honour an eminent scholar, esp. a colleague.

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